Using a Community Health Worker Model to Engage Fathers in Home Visitation

Background and Purpose: Home visitation programs primarily serve mothers and infants, with few services provided to fathers or other family members. Healthy Start, a federally funded program serving low-income parents, has prioritized father engagement in services. This study discusses a community health worker (CHW) model to engage fathers in home visitation services, developed in collaboration with Healthy Start programs in one Midwestern state. In this program, fatherhood CHWs were trained to conduct outreach, parent education, home visitation, and group-based programs with fathers and father figures. This presentation is focused on the implementation of the model using data from a multi-site evaluation, and examines factors that impeded or facilitated CHWs’ engagement of fathers in home visitation.

Methods: This presentation triangulates quantitative data, obtained from each Healthy Start program site on a quarterly basis, as well as qualitative data obtained from staff trainings, site visits, and through interviews with program staff. Data examines the process of program implementation at five sites in one state, including four urban sites and one rural tribal site. We describe the strengths and challenges of a community-based CHW approach to engaging fathers in home visitation.

Results: In 2019, sites engaged 181 fathers ranging from 67 fathers at one site to 12 fathers at another site. Fatherhood CHWs implemented 24/7 Dad, Fatherhood is Sacred & Partners for a Healthy Baby groups, and engaged 564 fathers in 73 group sessions. The university team trained 47 Healthy Start professionals on effective father engagement, at 2 project sites. Pre-test and post-test data of the staff training showed improvements in staff members’ willingness to engage fathers and beliefs in the importance of father involvement. Qualitative data point to four factors that impede or facilitate fatherhood program implementation. (1) Supervision and support. Some sites were hindered by leadership challenges, lack of communication between supervisor and Fatherhood CHW, and insufficient resources. (2) Fatherhood CHW experience and training. Fatherhood CHWs that had social services experience were more equipped to provide home visitation and outreach. Background and training in maternal and infant health was also critical. (3) Norms. Father involvement is an emerging priority in home visitation. For optimal success, it is necessary to shift norms within agencies to a family centered model of care, e.g., through staff training on father engagement. (4) Service location challenges at the rural site in particular.

Conclusions and Implications: A clear strength of the CHW model is that it has feasibility in community settings, which will likely enhance program sustainability. However, contextual factors vary considerably across sites, and these factors contribute to program implementation success and Fatherhood CHWs ability to engage fathers. Multiple levels must be considered: Fatherhood CHW training, supervisory support, programmatic resources, and local/ national policy. Two key overarching take home points observed across sites are that training the Healthy Start staff (who are mostly women) on the potential benefits of father engagement is highly beneficial, and even in well functioning programs, ongoing technical assistance to the Fatherhood CHW is critical for success.